Banphaeo General Hospital, Samutsakhon, Thailand.
Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
PLoS One. 2021 Apr 22;16(4):e0249867. doi: 10.1371/journal.pone.0249867. eCollection 2021.
Chikungunya virus (CHIKV) is an arthropod-borne virus transmitted by mosquitoes of the genus Aedes. CHIKV infection causes various rheumatic symptoms, including enthesitis; however, these effects are rarely investigated. The aim of this study was to describe the rheumatic manifestations in CHIKV infection, estimate the prevalence of enthesitis in CHIKV-infected patients, and determine the factors associated with CHIKV-induced enthesitis. We conducted a prospective, observational study in patients with CHIKV infection confirmed by positive RT-PCR or IgM assay from October 2019 to March 2020. Patients with pre-existing inflammatory rheumatic diseases were excluded. A rheumatologist evaluated the demographic and clinical characteristics of the patients, including the number of inflamed joints, enthesitis sites, tendinitis, and tenosynovitis. The Leeds enthesitis index (LEI) and the Maastricht ankylosing spondylitis enthesis score (MASES) were used to evaluate enthesitis sites. Factors associated with enthesitis were determined using logistic regression analysis. One hundred and sixty-four participants diagnosed with CHIKV infection were enrolled. The mean (SD) age of the patients was 48.2 (14) years. The most common pattern of rheumatic manifestations was polyarthritis with or without enthesitis. Enthesitis was observed in 63 patients (38.4%). The most common site of enthesitis was the left lateral epicondyle as assessed by LEI and the posterior superior iliac spine as assessed by MASES. Multivariate analysis indicated that the number of actively inflamed joints and Thai-HAQ score at the initial evaluation were significantly associated with the presence of enthesitis. The main rheumatic manifestations of CHIKV infection were arthritis/arthralgia, with enthesitis as a prominent extraarticular feature. CHIKV infection can cause enthesitis at peripheral and axial sites. We found that enthesitis was associated with a high number of inflamed joints and reduced physical function. These results indicate that the assessment of enthesitis should be considered when monitoring disease activity and as a treatment response parameter in CHIKV-infected patients.
基孔肯雅热病毒（CHIKV）是一种虫媒病毒，通过伊蚊属的蚊子传播。CHIKV 感染可引起各种风湿症状，包括附着点炎；然而，这些影响很少被研究。本研究的目的是描述 CHIKV 感染的风湿表现，估计 CHIKV 感染患者附着点炎的患病率，并确定与 CHIKV 引起的附着点炎相关的因素。我们进行了一项前瞻性、观察性研究，纳入了 2019 年 10 月至 2020 年 3 月间经 RT-PCR 或 IgM 检测阳性确诊的 CHIKV 感染患者。排除了患有预先存在的炎症性风湿性疾病的患者。风湿病学家评估了患者的人口统计学和临床特征，包括炎症关节的数量、附着点炎部位、肌腱炎和腱鞘炎。使用利兹附着点炎指数（LEI）和马斯特里赫特强直性脊柱炎附着点炎评分（MASES）评估附着点炎部位。使用逻辑回归分析确定与附着点炎相关的因素。共纳入 164 名诊断为 CHIKV 感染的患者。患者的平均（SD）年龄为 48.2（14）岁。最常见的风湿表现模式是关节炎/关节痛，伴有或不伴有附着点炎。63 名患者（38.4%）出现附着点炎。LEI 评估的最常见附着点炎部位是左侧外上髁，MASES 评估的最常见附着点炎部位是后上髂嵴。多变量分析表明，初始评估时活跃炎症关节的数量和泰国健康评估问卷（HAQ）评分与附着点炎的存在显著相关。CHIKV 感染的主要风湿表现为关节炎/关节痛，附着点炎是突出的关节外特征。CHIKV 感染可引起外周和轴向附着点炎。我们发现，附着点炎与大量炎症关节和身体功能下降有关。这些结果表明，在监测疾病活动和作为 CHIKV 感染患者的治疗反应参数时，应考虑评估附着点炎。
